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41]

Original Article
Histological evaluation of the cleaning
effectiveness of two reciprocating single-file
systems in severely curved root canals: Reciproc
versus WaveOne
Maira de Souza Carvalho1,
Emlio Carlos Sponchiado Junior2, Angela Delfina Bitencourt Garrido2,
Lucas da Fonseca Roberti Garcia3, Andr Augusto Franco Marques1

1
Department of Endodontics, State University of
Amazonas, Manaus, Amazonas, Brazil,
2
Department of Endodontics, Federal University of
Amazonas, Manaus, Amazonas, Brazil,
3
Department of Physiology and Pathology, Araraquara
Correspondence: Dr. Lucas da Fonseca Roberti Garcia School of Dentistry, Univ Estadual Paulista, Araraquara,
Email: drlucas.garcia@gmail.com So Paulo, Brazil

ABSTRACT
Objective: The aim of this study was to evaluate the cleaning effectiveness achieved with two reciprocating single-file
systems in severely curved root canals: Reciproc and WaveOne. Materials and Methods: Twenty-five mesial roots of
mandibular molars were randomly separated into two groups, according to the instrumentation system used. The negative
control group consisted of five specimens that were not instrumented. The mesial canals (buccal and lingual) in Reciproc
Group were instrumented with file R25 and the WaveOne group with the Primary file. The samples were submitted to
histological processing and analyzed under a digital microscope. Results: The WaveOne group presented a larger amount
of debris than the Reciproc Group, however, without statistically significant difference (P > 0.05). A larger amount of debris
in the control group was observed, with statistically significant difference to Reciproc and WaveOne groups (P < 0.05).
Conclusions: The two reciprocating single-file instrumentation systems presented similar effectiveness for root canal cleaning.

Key words: Cleaning, reciprocating single-file system, reciprocating motion

INTRODUCTION The use of reciprocating motion may be considered

Several advances in the techniques for the root canal
systems instrumentation have been obtained from the
development of nickel-titanium instruments (NiTi),
the main properties of these being their superelasticity,
flexibility, and shape memory effect.[1] These properties
have allowed the development of rotary instruments
with a variety of tapers, making biomechanical
preparation faster than manual instrumentation.[2,3]
as a recent innovation in mechanized root canal
instrumentation; with its differentiated kinematics
being described as a oscillatory movement in which
the instrument turns in the clockwise direction, and
then counter-clockwise before completing a full
360 rotation cycle.[4,5] Thus, the stress promoted on
the instrument is diminished, thereby considerably
reducing its risk of fracture and increasing its
lifespan.[6,7] Furthermore, the instruments are made
of a special metal alloy, denominated M-Wire, which

How to cite this article: Carvalho Md, Sponchiado Junior EC, Bitencourt Garrido AD, Roberti Garcia Ld, Franco Marques AA. Histological evaluation of
the cleaning effectiveness of two reciprocating single-file systems in severely curved root canals: Reciproc versus WaveOne. Eur J Dent 2015;9:80-6.

Copyright 2015 Dental Investigations Society. DOI: 10.4103/1305-7456.149648

80 European Journal of Dentistry, Vol 9 / Issue 1 / Jan-Mar 2015

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Carvalho, et al.: Cleaning effectiveness of reciproc and waveone systems
undergoes alternate cycles of cold and heat during
manufacture, which provides a significant increase
in their flexibility and mechanical strength.[7]
Among the instruments that are used in a
reciprocating movement during biomechanical
preparation, the Reciproc and WaveOne systems
are the most widely used.[8] These systems are sold
in a presterilized condition and are for a single use,
being discarded after instrumentation, which reduce
the risk of cross-contamination and instrument
fractures.[4] In addition, they have advantages in
comparison with conventional rotary systems,
as they allow biomechanical preparation to be
performed four times faster due to the use of a
single instrument.[6-8]
Both systems are composed of three instruments;
and perform three cycles of 120 until they complete
a 360 rotation. The files of the Reciproc system
are the R25 (red - 25.08), R40 (black - 40.06) and
R50 (yellow - 50.05), with the first two being
indicated for constricted or curved canals, and the
latter for normal and wide canals.[9] These files have
an S-shaped cross section, and when activated
by the motor, they perform a 150 rotation in the
counter-clockwise direction (cutting direction) and 30
in the clockwise direction, at a speed of approximately
300 rpm.[5,7,10]
On the other hand, the files of the WaveOne system
have a convex triangular cross section in the coronal
part and a modified convex triangular part at the tip,
being denominated Small (yellow - 21.06), used in
thin canals, Primary (red - 25.08), indicated for the
majority of canals, and Large (black - 40.08), used in
wide canals.[11] Their angle of rotation in the cutting
direction (counter-clockwise direction) is 170 and
in the relief direction (clockwise direction) of 50,
developing an approximate speed of 350 rpm.[5,7,10]
However, few studies have reported the cleaning
effectiveness of these new systems since the use of
only one instrument could compromise the removal
of debris from inside the root canals. Therefore,
the aim of this study was to compare the cleaning
effectiveness, by means of histological analysis, of
these two motor driven systems with reciprocating
movement kinematics in canals with an accentuated
curvature. The null hypothesis tested was there would
be no difference between the systems with regard to
their cleaning effectiveness.
European Journal of Dentistry, Vol 9 / Issue 1 / Jan-Mar 2015
MATERIALS AND METHODS
Teeth selection
To perform this study, 25 freshly extracted human
mandibular molar teeth, with prior approval from
the Research Ethics Committee (Protocol No. 120.956),
and according to Helsinky Declaration principles,
were selected. The teeth presented fully formed root
apices, minimum length of 16 mm, two mesial canals
with distinct foramen, 30 angle of curvature and
radius of curvature 10 mm.
The teeth were kept in 0.5% chloramine solution at
4C for 48 h for the disinfection, and next, washed
in running water for 24 h. After this, the teeth were
individually submitted to orthoradial radiograph
taken, using a digital sensor (Kodak RVG 5100,
Carestream Health Inc., Stuttgart, Germany) and
X-ray equipment (Spectro 70X, Dabi Atlante, Ribeiro
Preto, SP, Brazil) with exposure time of 0.4 s and
object-film distance of 10 cm.
After obtaining the radiographic images, these
were digitized, and with the aid of the AutoCAD
2012 software (Autodesk, San Rafael, CA, USA)
measurements were taken of the angle (in degrees)
and of the radius of curvature (in mm) of the mesial
root of each tooth. In order to measure the angle of
curvature of the root, the Schneider method was
followed,[12] by tracing a line (w) parallel to the long
axis of the root as from the canal opening orifices, and
another (x) that began in the apical foramen and ended
at the intersection with the first line, at the point where
the curvature of the root began. The acute angle ()
formed by these two lines determined its degree
of curvature. According to Pruett et al.,[13] there is a
point A and a point B on the lines w and x where the
curvature of the canal beings and ends, respectively.
These points are tangential to a circle whose radius (r),
in millimeters determines the radius of the curvature
of the canal. The center of the circle is defined by the
meeting of the straight lines y and z, which originate
at points A and B and are traced perpendicularly to
the lines w and x, respectively [Figure 1].
Biomechanical preparation
Coronal opening was performed with a spherical
diamond coated bur No. 1015 (KG Sorensen, So Paulo,
SP, Brazil), coupled at high speed device (Silent - MRS
350, Dabi Atlante, Ribeiro Preto, SP, Brazil) under
constant water cooling. The crowns of the teeth were
partially sectioned with a diamond disc (KG Sorensen)
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Carvalho, et al.: Cleaning effectiveness of reciproc and waveone systems
a b
Figure 1: (a) Calculation of the angle of curvature () of the mesial
root (b) determination of the radius of curvature (r) of the mesial root
close to the amelocement junction, to standardize the
mean length of the mesial root (both canals-buccal and
lingual) at 16 mm.
The working length was determined by inserting
a K-type file #10 (Dentsply/Maillefer Ballaigues,
Switzerland) in the apical direction until its tip was
visualized; and withdrawn 1 mm short of the apical
foramen.
With the purpose of keeping the teeth in the same
position during biomechanical preparation, a
matrix (2.0 cm 2.0 cm 2.0 cm) made of condensation
silicone (Perfil Denso, Vigodent, Rio de Janeiro, RJ,
Brazil), coupled to an acrylic base was used. After
manipulating the silicone, the roots were inserted
with the buccal surface parallel to one of the matrix
surfaces, leaving only the entrances of the mesial canals
out of the silicone. After silicone polymerization, the
root/matrix sets were removed from the acrylic base;
and the 25 silicone blocks containing the canals were
randomly assigned into two experimental groups,
which were submitted to instrumentation (n = 20), and
one group, considered the negative control (n = 10),
in which the canals were not instrumented.
The instruments of the tested systems were activated by
a Sirona handpiece (SN S 12345, Sirona Dental Systems
GmbH, Bensheim, Germany), with 6:1 reduction,
coupled to a VDW Silver Reciproc motor (VDW
GmbH, Munich, Germany).
The roots in the Reciproc Group were instrumented
only with file R25 (25.08/21 mm-VDW GmbH),
with the Reciproc ALL function predetermined by
the motor. Three movements of the instruments
were made with slight apical pressure until the
working length was attained. The first movement
corresponded to preparation of the cervical third;
82
the second to preparation of the middle third, and
the third, to preparation of the apical third. Between
one movement and the other, the instrument was
cleaned with sterile gauze and the canal irrigated
with 1 ml of 2.5% NaOCl solution (Cloro Rio 2.5%,
Indstria Farmacutica Rioqumica LTDA, So Jos
do Rio Preto, SP, Brazil), introduced at 3 mm short
of the apex, with the NaviTip irrigation tip coupled
to a syringe (Ultradent Products Inc., South Jordan,
UT, USA).
In the WaveOne Group, only the Primary
instrument (25.08/21 mm - Dentsply/Maillefer)
was used, driven by the same motor fitted for the
WaveOne ALL function. In the same mode as used in
the previous group, the specimens were instrumented
with the same three movements in the direction to
the apex, instrument cleaning and irrigation with
1 ml of 2.5% NaOCl solution between one movement
and the next, until the working length was attained.
After instrumentation in both groups (Reciproc and
WaveOne), the canals were irrigated with 2 ml of
2.5% NaOCl solution, following completion of the
instrumentation. Biomechanical preparation was
performed by only one professional in order to
standardize the procedure. Whereas, the specimens
of the negative control group were not instrumented.
Histological processing
After biomechanical preparation, the specimens
were fixed in 4% buffered formalin solution for 48 h,
washed in running water for 1 h, and immersed
in Morse solution for approximately 4 weeks for
decalcification, with periodic changes of solution
every 2 days. On the conclusion of the decalcification
process, the roots were cut perpendicularly to their
long axis at 5 mm from anatomical apex, to perform
the histotechnical processing. The root apices were
washed in running water, dehydrated in ascending
grades of alcohol (70%, 90%, 95%, and 100%) and
diaphanized in xylol for embedment in liquid paraffin
at approximately 60C. Semi-serial cuts 5-m thick
were made (15 semi-serial sections of each specimen)
and were stained with hematoxylin and eosin.
The histological cuts were analyzed under a digital
DinoLite Plus AM313T microscope (AnMo Electronics
Corporation, New Taipei City, Taiwan) at 60 and
230 magnifications. The images with reference to the
cuts were recorded as a tagged image file format and
submitted to evaluation using the Dino Capture 2.0
software (AnMo Electronics Corporation, New Taipei
City, Taiw). An integration grid containing 588
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Carvalho, et al.: Cleaning effectiveness of reciproc and waveone systems
points (0.9 cm 0.9 cm), generated by the software was
overlapped on each image obtained; thus allowing the
points present in the root canal to be counted [Figure 2].
The area occupied by the canal was considered the
total number of points present within the limits of the
root canal lumen, without concern about establishing
its absolute value since the isthmus region was not
considered. After counting the clean points and those
that presented the debris, the percentage of the points
with debris in the cross-section of the root canal was
calculated to determine the cleaning effectiveness of
each system. Before images analysis, any identification
of the groups was omitted, allowing blinded evaluation
by a single and duly trained observer.
Statistical analysis
The normal distribution of data was tested by the Shapiro
Wilks test and the values obtained (KruskalWallis,
the Dunn multiple comparisons test, P < 0.05) were
analyzed using the GraphPad InStat for Mac OS
software (GraphPad Software, La Jolla, CA, USA).
RESULTS
The mean values of debris, in percentage (%) in
the root canal lumen, may be seen in Table 1. In
both groups submitted to instrumentation, it was
possible to observe the presence of debris in the root
canal lumen. The WaveOne group presented larger
amount of debris than the Reciproc Group, however,
without statistically significant difference (P > 0.05).
Whereas, specimens in the control group, in
which no instrumentation was performed, a larger
amount of debris was observed with statistically
significant difference from the Reciproc and WaveOne
Groups (P < 0.05). Figures 3-5 present the debris
removal by the two instrumentation systems and the
negative control group.
Figure 2: Integration grid overlapped on image at 230. The yellow
points indicate presence of debris (H and E)
European Journal of Dentistry, Vol 9 / Issue 1 / Jan-Mar 2015
DISCUSSION
The aim of this study was to compare the cleaning
effectiveness of two single-file instrumentation
systems with reciprocating movement kinematics.
Based on the results obtained, it can be affirmed that
the tested hypothesis was accepted since the two
systems evaluated presented a similar behavior with
regard to cleaning effectiveness.
In spite of the complex and variable anatomy of root
canal systems, in the present study, standardization
criteria were used to guarantee comparability
among the groups. The first of these was the exact
determination of the degree of curvature of the mesial
roots, by selecting teeth with a 30 angle of curvature,
considered severely. [12] Whereas, the radius of
curvature adopted (10 mm) represents how abruptly
a specific angle of curvature occurs when the canal
deviates from the straight line; that is, the smaller the
radius of the circle traced, the more accentuated is
the curvature of the root canal.[13] However, because
they are independent measurements, the canals
may present equal angulations with different radii.
Table 1: Mean values (%) and SD of the amount of
debris remaining after instrumentation in the apical
third of the root canal
Control group Reciproc group Waveone group
61.766.51a 25.357.06b 28.9613.21b
Different lower case letters in line indicate statistically significant difference
among groups. Dunns multiple comparisons test categories with the same
letter are not statistically different from each other (P<0.05). Kruskal-Wallis,
Dunns multiple comparisons test-P>0.05. P=0.07. SD: Standard deviation,
a,b,c
=P value=0.07
b c
Figure 3: Representative image of the cross-section at the apical
area from specimen of Reciproc Group (a) panoramic view of the
histological cut at lower magnification (60), showing two distinct
canals (mesiobuccal and mesiolingual), with flattening of the mesial
root (arrows) (b) Canal presenting flattening area and presence of
debris (smaller arrow). Note the limit area of the instrument action
(larger arrow) (c) Canal with circular configuration (230) and absence
of debris (H and E)
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Carvalho, et al.: Cleaning effectiveness of reciproc and waveone systems
a
b c
Figure 4: Representative image of the cross-section at the apical
area from specimen of WaveOne Group (a) panoramic view of the
histological cut at lower magnification (60), showing the isthmus
area between the canals, with presence of debris (arrows) (b and c)
canals at greater magnification (230) showing evidence of debris in
the root canal lumen (smaller arrows) and in the isthmus area (larger
arrows) (H and E)
Therefore, with the standards adopted, the teeth could
simulate clinical situations that represent difficulty in
performing endodontic treatment.[14,15]
The action of endodontic instruments against dentinal
walls results in the main root canal with a progressively
conical shape, however, at all times respecting its original
anatomy.[16] With the reciprocating movement proposed
by Yared,[4] the use of one single instrument for cleaning
and shaping the root canal system has led to a new
paradigm. Biomechanical preparation is performed
starting with the gradual entry of the instruments (R25
and primary), using a crown-down technique.[4,9]
In the present study, the instruments R25 (Reciproc)
and Primary (WaveOne) were used, since the
manufacturers recommended the use of these
instruments in canals with accentuated curvature,
since manual instruments would not be capable
of passively reaching the working length in these
cases.[8] Furthermore, according to the manufacturers
instructions, the instruments were discarded after
biomechanical preparation, since their use is
recommended in one single tooth; that is, for the
preparation of 3 or 4 canals in the case of molars.
However, Park et al.[17] have reported, by means of
scanning electron microscopy, that instruments of
the Reciproc and WaveOne systems may be used in
approximately 5 canals without significant alterations
occurring on their surface, suggesting the possibility
of reusing the instruments.
84
a
b c
Figure 5: Representative image of the cross-section at the apical level
from specimen of the control group. Smaller and greater magnification
of the canals, highlighting the large amount of debris (arrows)
(c) Irregular walls of noninstrumented canals (indication) (H and E)
Considering the main objective of this study, only
NaOCl solution, at the concentration of 2.5% was used
after each gradual entry of the instruments, to avoid
the influence of different irrigant solutions. NaOCl is
the solution of first choice for performing endodontic
treatment because, in addition to the mechanical
flushing action of debris from within the root canal
system, it promotes the dissolution of organic tissue.[18]
Moreover, so that there would be no alterations in the
result of the cleaning effectiveness due to the use of
NaOCl, the amount of solution used and the depth
of irrigation were standardized in the two groups
submitted to instrumentation.
During the histological analysis, it was found that
there were several configurations of the root canal
systems, in spite of standardization as regards the
severity of curvature of the roots used. In the cases
of ribbon-shaped canals, or those with the presence
of isthmus, the area with debris was larger than
it was in those with a circular format.[14] Circular
canals provide a greater area of contact of the NiTi
instruments, which have a cylindrical format and act
in a centralized mode.[19]
Brklein et al., [8] when evaluating the cleaning
effectiveness of the same systems by means of scanning
electron microscopy, found that the Reciproc system
promoted greater debris removal than the WaveOne
system, in the apical third. This fact may be explained
by the difference in cross-section of the instruments.
While the S-shaped cross-section in the Reciproc
instruments provides the presence of deeper grooves,
which favors debris removal, the convex triangular
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Carvalho, et al.: Cleaning effectiveness of reciproc and waveone systems
format in the WaveOne instruments creates thick metal
core with shallow grooves and lower debris removal
effectiveness.[20] In addition, the systems have different
amplitudes of cutting movement, being 150 for Reciproc
and 170 for WaveOne. Although recent studies have
demonstrated that there is no difference in the percentage
increase in area after instrumentation with the R25 and
Primary files,[21,22] when one associates the wider angle
of advance in the cutting direction (counter-clockwise)
of the WaveOne system with the lower depths of its
grooves, this may explain the inferior performance in
regard to debris removal during instrumentation.
Nevertheless, this behavior was not observed in the
present study since both systems presented similar
effectiveness with regard to the cleaning effectiveness
in the apical third of the root canal. In the study of
Brklein et al.,[8] the action of these instruments was
evaluated in the three root thirds, and only in the
apical third was there significant difference as regards
cleaning effectiveness. In the present study, the authors
choose to evaluate only the apical third, as it is known
that the cleanliness of root canal systems diminishes
as the instrument advances from the cervical into the
apical direction,[23,24] making the results more relevant.
However, the authors believe that further studies must
be conducted to elucidate these facts.
These single-file systems are clinically more attractive,
because they allow a significant reduction in the time
of their application when compared with multiple
instrument systems.[6,20,25] However, the reduction
in operative time when single-file systems are used
significantly diminish the time of irrigation and
chemical debridement of root canal systems.[8] This
situation must be compensated with the use of larger
volumes of irrigant solution and its activation to
promote the chemical dissolution of debris and promote
adequate disinfection of the root canal system.[8] It is
known that a lower amount of debris accumulates
when the canal is irrigated more frequently.[2]
Despite the limitations of this in vitro study, it may be
concluded that the Reciproc and WaveOne systems
have similar cleaning effectiveness in the apical third of
severely curved root canals. However, further studies are
needed to clarify the mechanisms involved in improving
the cleaning effectiveness of the root canal system.
ACKNOWLEDGMENT
The authors of this study would like to thank the Fundao
de Amparo Pesquisa do Estado do Amazonas (FAPEAM)
for the financial support.
European Journal of Dentistry, Vol 9 / Issue 1 / Jan-Mar 2015
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86 European Journal of Dentistry, Vol 9 / Issue 1 / Jan-Mar 2015